A Survey of Attitude on Sperm Banking and Barriers to Its Use among Testicular Cancer Patients in a Multicultural Asian Population

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Authors provide an interesting assessment on the overall situation regarding sperm banking prior to testicular cancer treatment in Malaysia analysing possible influencing factors such as religious status and medical advice.

Only about half of the patients (62/102) responded to the questionnaire whatsoever. Why was compliance so low?

Can you provide sperm parameters of the cryopreserved samples?

Cost data should be provided in US dollars for universal comparison

Author Response

Thank you for your comments. Please find the attachment for my response.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

I read with particular interest the following article, which examines the attitudes and use of sperm banking, assesses its impact on pregnancy outcomes and identifies barriers to its use at the Sarawak General Hospital in Kuching, Malaysia. Overall, the article is well written. Despite the importance of this topic, the sample size bias cannot be underestimated. The article states that patients were contacted by phone call and, after giving informed consent, questionnaires were administered. However, the number of patients contacted is very small and the number of people who actually were included is even smaller. This is a major limitation of the current study.  To understand the small number of cases, I suggest explaining the situation of the sperm bank in Malaysia. Authors should explain the general situation of sperm banks in Malaysia and provide data. How many sperm banking Centres are there in Malaysia? How many sperm cryopreservation procedures were performed in one year? The authors look at Hospital Sultanah Aminah Johor Bahru and Sarawak General Hospital in Malaysia. How many cases of neoplasia are seen in these hospitals each year? What is the proportion of testicular tumours?

I understand the importance and the message of the study. But the paper needs to be implemented with data that shows the general situation of sperm banks. Otherwise, the reader might think that this situation is specific to these centres. Paper is poor in this version. It would be advisable to increase the number of patients contacted and enrolled, or to explain the limitations of this study, in order to make this article more scientifically relevant.

I suggest a figure in which the authors should indicate the number of patients included in the study, the number of patients who cryopreserved semen and the number of patients who did not opt for cryopreservation.

Tab. 1 and Tab.2 - Please specify the meaning of <RM2000, RM2000-RM4000, >RM4000.

Discussion – line 2 page 6: Please,  rewrite “people with testicular cancer diagnosis”

The paper is not acceptable in its current form. It must be implemented, otherwise it will be rejected.

Author Response

Thank you for your comments. Please find the attachment for my response

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Comments for author File: Comments.pdf

Author Response

Thank you for your comments. Please find the attachment for my response.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

None

Author Response

Thank you for your thorough and insightful review of my manuscript. Your constructive feedback has been invaluable in enhancing the quality of my work.

Reviewer 3 Report

Comments and Suggestions for Authors

Comments for author File: Comments.pdf

Author Response

Thanks for your comments. Please find the attachment below for my response.

Author Response File: Author Response.pdf